Provider Demographics
NPI:1003306879
Name:PRIVATE PASSION ELDERLY CARE
Entity type:Organization
Organization Name:PRIVATE PASSION ELDERLY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-449-7059
Mailing Address - Street 1:37522 PARK FOREST CT
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-4645
Mailing Address - Country:US
Mailing Address - Phone:661-480-5648
Mailing Address - Fax:661-480-5648
Practice Address - Street 1:37522 PARK FOREST CT
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4645
Practice Address - Country:US
Practice Address - Phone:661-480-5648
Practice Address - Fax:661-480-5648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health